Immersive virtual reality versus aromatherapy for reducing anxiety, pain and physiological stress during oral surgery: a randomized controlled trial

Preoperative anxiety is common during third molar extractions and is associated with heightened pain perception and physiological changes. Non-pharmacological strategies such as virtual reality (VR) aromatherapy have shown potential to alleviate perioperative distress, though comparative evidence remains scarce. This randomized controlled trial included 279 patients undergoing included third molar extraction under local anesthesia, assigned to immersive VR, lavender aromatherapy or control conditions. Anxiety (State-Trait Anxiety Inventory, STAI), physiological parameters—heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and oxygen saturation (SAT)—and postoperative pain (Visual Analog Scale, VAS) were evaluated at predefined time points. Both interventions significantly reduced anxiety levels (state anxiety aromatherapy: r = 0.40, p = 0.01; state anxiety VR: r = 0.39, p < 0.001), with slightly larger effect sizes in the aromatherapy group. HR decreased across all groups, most markedly with aromatherapy ( r = 0.60). SAT increased significantly in the VR group ( r = 0.49), while aromatherapy produced the most marked reductions in SBP ( r = 0.39) and DBP ( r = 0.21). Postoperative pain was significantly lower with aromatherapy (VAS 11.99 ± 8.04 mm vs. 16.23 ± 9.10 mm in control, p = 0.04), whereas VR showed a non-significant trend ( p = 0.07). In conclusion, both immersive VR and lavender aromatherapy were associated with reduced perioperative anxiety in patients undergoing third molar extraction. Aromatherapy showed greater benefits in postoperative pain, whereas VR demonstrated a non-significant trend toward pain reduction. Physiological differences between groups were small and of uncertain clinical relevance.